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Background: In Mexico and the world, breast cancer is the cancer type with the highest incidence and mortality for women. Its incidence has increased due to a higher life expectancy and a higher exposure to risk factors. Screening is done by mammography using the BIRADS (Breast Imaging Reporting and Data System) system, the standard for mammography screening report which classifies lesions assigning recommendations for patient follow-up. The system goes from 0 (not conclusive) to 6 (demonstrated malignancy), being of interest for this study the BIRADS 0 category. Objective: To describe patients classified as BIRADS 0 by mammography and their reclassification in a first-level hospital during 2021. Material and methods: Retrospective, descriptive, cross-sectional, observational study. Women over 40 years with a BIRADS 0 result were studied. The following databases were used: Institutional Cancer Registry, Family Medicine Information System, Electronic Clinical File, and the mammography and patient list from preventive medicine. Results: Reclassification by ultrasound (US) was achieved in 100% of patients, in all of the BIRADS US categories. In 3.8% of BIRADS 0 patients, ductal adenocarcinoma was found and confirmed by histological testing. Conclusion: All of the reassessed lesions with US were adequately reclassified.
Introducción: en México y el mundo, el cáncer de mama causa la mayor mortalidad por cáncer en mujeres. Su incidencia ha incrementado por una mayor esperanza de vida y exposición a factores de riesgo. El tamizaje de esta enfermedad se hace mediante mastografía, y para la estratificación de las lesiones se utiliza el sistema BIRADS (Breast Imaging Reporting and Data System), que estandariza el informe, categoriza las lesiones según el grado de sospecha y asigna recomendaciones a seguir. Dicho sistema va desde 0 (no concluyente) hasta 6 (lesión con malignidad demostrada) y es de interés para este estudio la categoría 0. Objetivo: describir la reclasificación de pacientes con reporte BIRADS 0 por mastografía durante 2021 en una unidad de primer nivel de atención. Material y métodos: estudio retrospectivo, descriptivo, transversal, observacional. Se estudiaron mujeres mayores de 40 años con resultado BIRADS 0. Se utilizaron las siguientes bases de datos: Registro Institucional de Cáncer, Sistema de Información de Medicina Familiar, Expediente Clínico Electrónico y lista nominal de mastografías y censo de pacientes sospechosos de medicina preventiva. Resultados: la reclasificación con ultrasonido (US) se logró en el 100% de pacientes, en todas las categorías de BIRADS US. En el 3.8% se confirmó carcinoma ductal por histología en las pacientes inicialmente categorizadas como BIRADS 0. Conclusiones: la totalidad de lesiones reevaluadas con US fueron reclasificadas satisfactoriamente.
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Neoplasias da Mama , Mamografia , Humanos , Estudos Transversais , Feminino , Estudos Retrospectivos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/classificação , Mamografia/normas , Pessoa de Meia-Idade , Adulto , Idoso , México , Ultrassonografia Mamária , Idoso de 80 Anos ou mais , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normasRESUMO
BACKGROUND: Mental health problems and suicide ideation are common in adolescents. Early detection of these issues could prevent the escalation of mental health-related symptoms in the long term. Moreover, characterizing different profiles of prevalent symptoms in conjunction with emotional regulation strategies could guide the design of specific interventions. The use of web-based screening (WBS) tools has been regarded as a suitable strategy to timely detect symptomatology while improving the appeal, cost, timeliness, and reach of detection in young populations. However, the evidence regarding the accuracy of these approaches is not fully conclusive. OBJECTIVE: The study aims (1) to examine the capability of a WBS to identify adolescents with psychiatric symptoms and suicidality and (2) to characterize the mental health profiles of a large sample of adolescents using WBS. METHODS: A total of 1599 Latin American Spanish-speaking adolescents (mean age 15.56, SD 1.34 years), consisting of 47.3% (n=753) female, 98.5% Chilean (n=1570), and 1.5% Venezuelan (n=24) participants, responded to a mental health WBS. A randomized subsample of participants also responded to the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). McNemar χ2 and receiver-operating characteristic curves tested the detection accuracy of WBS contrasted with the MINI-KID. Latent profile analyses explored the symptomatic and emotional regulation profiles of participants. RESULTS: Both measures showed an adequate level of agreement (area under the curve per symptom domain ranging from 0.70 to 0.89); however, WBS yielded a higher prevalence than MINI-KID for all psychiatric symptoms, except suicide ideation and depression. Latent profile analyses yielded 4 profiles-one of them presented elevated psychopathological symptoms, constituting 11% of the sample (n=175). Rumination (odds ratio [OR] 130.15, 95% CI 51.75-439.89; P<.001), entrapment (OR 96.35, 95% CI 29.21-317.79; P<.001), and defeat (OR 156.79, 95% CI 50.45-487.23; P<.001) contributed significantly to the prediction of latent profile memberships, while cognitive reappraisal did not contribute to the prediction of any latent profile memberships, and expressive suppression was only associated to profile-2 membership. CONCLUSIONS: WBS is acceptable for the timely detection of adolescents at risk of mental health conditions. Findings from the symptomatic and emotional regulation profiles highlight the need for comprehensive assessments and differential interventions.
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From the various perspectives of machine learning (ML) and the multiple models used in this discipline, there is an approach aimed at training models for the early detection (ED) of anomalies. The early detection of anomalies is crucial in multiple areas of knowledge since identifying and classifying them allows for early decision making and provides a better response to mitigate the negative effects caused by late detection in any system. This article presents a literature review to examine which machine learning models (MLMs) operate with a focus on ED in a multidisciplinary manner and, specifically, how these models work in the field of fraud detection. A variety of models were found, including Logistic Regression (LR), Support Vector Machines (SVMs), decision trees (DTs), Random Forests (RFs), naive Bayesian classifier (NB), K-Nearest Neighbors (KNNs), artificial neural networks (ANNs), and Extreme Gradient Boosting (XGB), among others. It was identified that MLMs operate as isolated models, categorized in this article as Single Base Models (SBMs) and Stacking Ensemble Models (SEMs). It was identified that MLMs for ED in multiple areas under SBMs' and SEMs' implementation achieved accuracies greater than 80% and 90%, respectively. In fraud detection, accuracies greater than 90% were reported by the authors. The article concludes that MLMs for ED in multiple applications, including fraud, offer a viable way to identify and classify anomalies robustly, with a high degree of accuracy and precision. MLMs for ED in fraud are useful as they can quickly process large amounts of data to detect and classify suspicious transactions or activities, helping to prevent financial losses.
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Objective: To compare the adequacy, agreement, and acceptability of Papanicolaou testing (cytology) for cervical cancer screening using self-collected samples compared to physician-collected samples in Grenada in the Caribbean. Furthermore, the study identifies the human papillomavirus (HPV) genotypes present among asymptomatic women testing positive for HPV, the etiologic cause of cervical cancer. Methods: Participants were divided into two groups and two cervical samples were collected from the women in each group: a self-collected sample and a physician-collected sample. Cervical specimens were tested for cytology and HPV. HPV genotyping was performed on positive specimens. Results: Self-collected samples were adequate and in agreement with physician-collected samples, showing no difference between the two sampling methods. Oncogenic high-risk HPV genotypes were identified in cervical samples which were positive for atypical squamous cells and low-grade squamous intraepithelial lesions. The high-risk HPV genotypes found, notably HPV 45 and 53, differed from those most commonly reported. Although the commonly reported high-risk genotypes HPV 16 and 18 were found, so were 31, 33, 35, 52, 66, 68, and 82. Conclusions: Using self-collection facilitated the discovery of unexpected HPV genotypes among asymptomatic women in Grenada. These findings add new information to the literature regarding cervical cancer and neoplasia screening and HPV genotypes in the Caribbean. This genotype information may impact surveillance of women with low-grade lesions, HPV vaccine selection, and possibly further vaccine research. Research regarding HPV in Caribbean pathology samples of cervical neoplasia and cancer is needed.
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OBJECTIVE: This study aimed to assess ethnic inequalities in the coverage and utilization of cancer screening services among women in Peru. METHODS: Data from the 2017-2023 Demographic and Family Health Survey in Peru were analyzed to evaluate ethnic disparities in screening coverage for breast and cervical cancer, including clinical breast examination (CBE), Pap smear test (PST), and mammography. Measures such as the GINI coefficient and Slope Index of Inequality (SII) were used to quantify coverage and utilization disparities among ethnic groups. RESULTS: The study included 70,454 women aged 30-69. Among women aged 40-69, 48.31% underwent CBE, 84.06% received PST, and 41.69% underwent mammography. It was found inequalities in coverage for any cancer screening (GINI: 0.10), mammography (GINI: 0.21), CBE (GINI: 0.19), and PST (GINI: 0.06), in 25 Peruvian regions. These inequalities were more pronounced in regions with larger populations of Quechua, Aymara, and Afro-Peruvian women. In rural areas, Quechua or Aymara women (SII: -0.83, -0.95, and - 0.69, respectively) and Afro-Peruvian women (SII: -0.80, -0.92, and - 0.58, respectively) experienced heightened inequalities in the uptake of CBE, mammography, and PST, respectively. Like Quechua or Aymara women (SII: -0.50, SII: -0.52, and SII: -0.50, respectively) and Afro-Peruvian women (SII: -0.50, SII: -0.58, and SII: -0.44, respectively) with only a primary education. CONCLUSION: Ethnic inequalities affect breast and cervical cancer screening coverage across regions in Peru. In Quechua, Aymara, and Afro-Peruvian women the uptake of mammography, CBE, and PST was less frequently than their white or mestizo counterparts. These inequalities are attributed to sociodemographic conditions such as lower education levels and residence in rural or non-capital areas.
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Neoplasias da Mama , Detecção Precoce de Câncer , Disparidades em Assistência à Saúde , Mamografia , Teste de Papanicolaou , Neoplasias do Colo do Útero , Humanos , Feminino , Peru/etnologia , Pessoa de Meia-Idade , Adulto , Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Mamografia/estatística & dados numéricos , Idoso , Teste de Papanicolaou/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/etnologia , Etnicidade/estatística & dados numéricos , Fatores Socioeconômicos , Esfregaço Vaginal/estatística & dados numéricosRESUMO
This commentary delves into the evolving landscape of cancer incidence and mortality in Costa Rica, presenting a comprehensive analysis of the data. Key findings reveal a concerning upward trajectory in cancer incidence rates, placing Costa Rica at the forefront within Central America. While prostate cancer and breast cancer dominate, disparities emerge when scrutinizing gender-specific trends. Notably, stomach and cervical cancers show declines, potentially attributed to targeted interventions. However, colorectal and liver cancers witness mortality increases, necessitating strategic responses. Geographical disparities persist across provinces, highlighting the need for equitable healthcare access. In conclusion, this commentary underscores the urgency of addressing the burgeoning cancer burden in Costa Rica, calling for evidence-based interventions and collaborative efforts on a global scale.
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Objective: To evaluate the indications for and results of magnetic resonance imaging (MRI) examinations for breast cancer screening at a cancer center in Brazil. Materials and Methods: This was a retrospective observational study, based on electronic medical records, of patients undergoing MRI for breast cancer screening at a cancer center in Brazil. Results: We included 597 patients between 19 and 82 years of age. The main indications for MRI screening were a personal history of breast cancer, in 354 patients (59.3%), a family history of breast cancer, in 102 (17.1%), and a confirmed genetic mutation, in 67 (11.2%). The MRI result was classified, in accordance with the categories defined in the Breast Imaging Reporting and Data System, as benign (category 1 or 2), in 425 patients (71.2%), probably benign (category 3), in 143 (24.0%), or suspicious (category 4 or 5), in 29 (4.9%). On MRI, 11 malignant tumors were identified, all of which were invasive carcinomas. Among those 11 carcinomas, six (54.5%) were categorized as minimal cancers (< 1 cm), and the axillary lymph nodes were negative in 10 (90.9%). The cancer detection rate was 18.4/1,000 examinations, and the positive predictive value for suspicious lesions submitted to biopsy was 37.9%. Conclusion: In our sample, the main indication for breast MRI screening was a personal history of breast cancer. The results indicate that MRI is a highly accurate method for the early detection of breast neoplasms in this population.
Objetivo: Avaliar as indicações e resultados de exames de ressonância magnética (RM) para rastreamento de câncer de mama em um centro oncológico no Brasil. Materiais e Métodos: Estudo observacional, realizado mediante análise retrospectiva de pacientes submetidos a RM das mamas para rastreamento de câncer de mama, por meio de revisão do prontuário eletrônico em um centro oncológico. Resultados: Foram incluídas 597 pacientes com idade variando de 19 a 82 anos. As principais indicações para rastreamento foram história pessoal de câncer de mama em 354 (59,3%) pacientes, história familiar em 102 (17,1%) e mutação genética confirmada em 67 (11,2%). O resultado da RM foi benigno (BI-RADS 1 ou 2) em 425 (71,2%) pacientes, provavelmente benigno (BI-RADS 3) em 143 (24,0%) e suspeito (BI-RADS 4 ou 5) em 29 (4,9%). Foram identificados 11 tumores malignos na RM, todos carcinomas invasivos, porcentagem de cânceres "mínimos" (< 1 cm) de 54,5% e porcentagem de axila negativa de 90,9%. A taxa de detecção de câncer na RM foi 18,4/1000 exames e o valor preditivo positivo para as lesões suspeitas submetidas a biópsia foi 37,9%. Conclusão: A principal indicação para RM de rastreamento na nossa população foi história pessoal de câncer de mama. Os resultados mostraram que a RM constitui um método com alta acurácia para detecção precoce de neoplasias da mama nessa população.
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OBJECTIVES: Li-Fraumeni syndrome (LFS) is a cancer syndrome associated with early-onset neoplasias. The use of whole-body magnetic resonance imaging (WBMRI) is recommended for regular cancer screening, however, evidence supporting the benefits in asymptomatic LFS patients is limited. This study aims to assess the clinical utility of WBMRI in germline TP53 mutation carriers at baseline and follow-up. MATERIALS AND METHODS: We systematically searched PubMed, Cochrane, and Embase databases for studies evaluating WBMRI as an early detection method for tumor screening in patients with LFS. We pooled the prevalence of the included variables along with their corresponding 95% confidence intervals (CIs). Statistical analyses were performed using R software, version 4.3.1. RESULTS: From 1687 results, 11 comprising 703 patients (359 females (51%); with a median age of 32 years (IQR 1-74)) were included. An estimated detection rate of 31% (95% CI: 0.28, 0.34) for any suspicious lesions was found in asymptomatic TP53 carriers who underwent baseline WBMRI. A total of 277 lesions requiring clinical follow-up were identified in 215 patients. Cancer was confirmed in 46 lesions across 39 individuals. The estimated cancer diagnosis rate among suspicious lesions was 18% (95% CI: 0.13, 0.25). WBMRI detected 41 of the 46 cancers at an early-disease stage, with an overall detection rate of 6% (95% CI: 0.05, 0.08). The incidence rate was 2% per patient round of WBMRI (95% CI: 0.01, 0.04), including baseline and follow-up. CONCLUSION: This meta-analysis provides evidence that surveillance with WBMRI is effective in detecting cancers in asymptomatic patients with LFS. CLINICAL RELEVANCE STATEMENT: Our study demonstrates that whole-body MRI is an effective tool for early cancer detection in asymptomatic Li-Fraumeni Syndrome patients, highlighting its importance in surveillance protocols to improve diagnosis and treatment outcomes. KEY POINTS: Current evidence for whole-body MRI screening of asymptomatic Li-Fraumeni Syndrome (LFS) patients remains scarce. Whole-body MRI identified 41 out of 46 cancers at an early stage, achieving an overall detection rate of 6%. Whole-body MRI surveillance is a valuable method for detecting cancers in asymptomatic LFS patients.
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Background: The aim of this study was to examine some psychometric characteristics of the Chilean-adapted version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT-24) (24) in a group of unselected children (community sample). This version was administered remotely through an online version during the pandemic period to caregivers of children, aged 18-24 months, registered in four primary care polyclinics of the Health Service Araucanía Sur, Chile. Methods: An intentional non-probabilistic sampling was used. Three hundred and thirteen toddlers were examined. Participants completed an online version of the Q-CHAT-24 which was disseminated through the REDCap platform. Evidence of reliability through internal consistency and evidence of predictive validity through ROC curve analysis were realized. Results: The mean age of the children evaluated was 21.16 months. The Shapiro-Wilk test revealed that Q-CHAT-24 scores was normally distributed. 71 cases (23.12%) scored 38 points or more on the Q-CHAT-24, qualifying as Autistic Risk. 48 cases (15.63%) were confirmed as autistic through the ADOS-2 Module T. All items were positively correlated with Q-CHAT-24 total score. All items were positively correlated with Q-CHAT-24 total score. Internal consistency was acceptable for the Q-CHAT-24 (Cronbach ´s α=0.78). The internal consistencies were analyzed for the Q-CHAT-24 Factors, and they were good for factor 1 "Communication and Social Interaction" (Cronbach ´s α=0.85) and acceptable for factor 2 "Restrictive and Repetitive Patterns" (Cronbach ´s α=0.74). Receiver operating characteristic (ROC) curve analyses were performed. The AUC values were 0.93 with statistical significance (p<0.01). For the cut-off point of 38, the Sensitivity, Specificity and Youden index values were 0.89, 0.8 and 0.7, respectively. The Positive Predictive Value (PPV) was 86% and the Negative Predictive Value (NPV) was 85%. Conclusions: In accordance with the objectives of this study, evidence of reliability and predictive validity was demonstrated for the Q-CHAT-24 in this Chilean population. More importantly, this study provides Sensitivity and Specificity data for a remote application version of an autism screening tool already validated in Chile. The implications of this have to do with the possibility of establishing a remote assessment system for children at risk of autism on a population scale.
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The aim of this study was to assess, through a systematic review, the status of infrared thermography (IRT) as a diagnostic tool for skin neoplasms of the head and neck region and in order to validate its effectiveness in differentiating benign and malignant lesions. A search was carried out in the LILACS, PubMed/MEDLINE, SCOPUS, Web of Science and EMBASE databases including studies published between 2004 and 2024, written in the Latin-Roman alphabet. Accuracy studies with patients aged 18 years or over presenting benign and malignant lesions in the head and neck region that evaluated the performance of IRT in differentiating these lesions were included. Lesions of mesenchymal origin and studies that did not mention histopathological diagnosis were excluded. The systematic review protocol was registered in the PROSPERO database (CRD42023416079). Reviewers independently analyzed titles, abstracts, and full-texts. After extracting data, the risk of bias of the selected studies was assessed using the QUADAS - 2 tool. Results were narratively synthesized and the certainty of evidence was measured using the GRADE approach. The search resulted in 1,587 records and three studies were included. Only one of the assessed studies used static IRT, while the other two studies used cold thermal stress. All studies had an uncertain risk of bias. In general, studies have shown wide variation in the accuracy of IRT for differentiating between malignant and benign lesions, with a low level of certainty in the evidence for both specificity and sensitivity.